Hypotensive lipid-containing biodegradable intraocular implants and related methods

ABSTRACT

Biocompatible intraocular implants include a prostamide component and a biodegradable polymer that is effective in facilitating release of the prostamide component into an eye for an extended period of time. The prostamide component may be associated with a biodegradable polymer matrix, such as a matrix of a two biodegradable polymers. The implants may be placed in an eye to treat or reduce a at least one symptom of an ocular condition, such as glaucoma.

BACKGROUND

The present invention generally relates to devices and methods to treatan eye of a patient, and more specifically to intraocular implants thatprovide extended release of a therapeutic agent to an eye in which theimplant is placed to treat ocular hypertension, such as by reducing orat least maintaining intraocular pressure, and to methods of making andusing such implants.

Ocular hypotensive agents are useful in the treatment of a number ofvarious ocular hypertensive conditions, such as post-surgical andpost-laser trabeculectomy ocular hypertensive episodes, glaucoma, and aspresurgical adjuncts.

Glaucoma is a disease of the eye characterized by increased intraocularpressure. On the basis of its etiology, glaucoma has been classified asprimary or secondary. For example, primary glaucoma in adults(congenital glaucoma) may be either open-angle or acute or chronicangle-closure. Secondary glaucoma results from pre-existing oculardiseases such as uveitis, intraocular tumor or an enlarged cataract.

The underlying causes of primary glaucoma are not yet known. Theincreased intraocular tension is due to the obstruction of aqueous humoroutflow. In chronic open-angle glaucoma, the anterior chamber and itsanatomic structures appear normal, but drainage of the aqueous humor isimpeded. In acute or chronic angle-closure glaucoma, the anteriorchamber is shallow, the filtration angle is narrowed, and the iris mayobstruct the trabecular meshwork at the entrance of the canal ofSchlemm. Dilation of the pupil may push the root of the iris forwardagainst the angle, and may produce pupillary block and thus precipitatean acute attack. Eyes with narrow anterior chamber angles arepredisposed to acute angle-closure glaucoma attacks of various degreesof severity.

Secondary glaucoma is caused by any interference with the flow ofaqueous humor from the posterior chamber into the anterior chamber andsubsequently, into the canal of Schlemm. Inflammatory disease of theanterior segment may prevent aqueous escape by causing completeposterior synechia in iris bombe and may plug the drainage channel withexudates. Other common causes are intraocular tumors, enlargedcataracts, central retinal vein occlusion, trauma to the eye, operativeprocedures and intraocular hemorrhage.

Considering all types together, glaucoma occurs in about 2% of allpersons over the age of 40 and may be asymptotic for years beforeprogressing to rapid loss of vision. In cases where surgery is notindicated, topical beta-adrenoreceptor antagonists have traditionallybeen the drugs of choice for treating glaucoma.

Prostaglandins were earlier regarded as potent ocular hypertensives;however, evidence accumulated in the last two decades shows that someprostaglandins are highly effective ocular hypotensive agents and areideally suited for the long-term medical management of glaucoma. (See,for example, Starr, M. S. Exp. Eye Res. 1971, 11, pp. 170-177; Bito, L.Z. Biological Protection with Prostaglandins Cohen, M. M., ed., BocaRaton, Fla., CRC Press Inc., 1985, pp. 231-252; and Bito, L. Z., AppliedPharmacology in the Medical Treatment of Glaucomas Drance, S. M. andNeufeld, A. H. eds., New York, Grune & Stratton, 1984, pp. 477-505).Such prostaglandins include PGF_(2α), PGF_(1α), PGE₂, and certainlipid-soluble esters, such as C₁ to C₅ alkyl esters, e.g. 1-isopropylester, of such compounds.

In U.S. Pat. No. 4,599,353 certain prostaglandins, in particular PGE₂and PGF₂α and the C₁ to C₅ alkyl esters of the latter compound, werereported to possess ocular hypotensive activity and were recommended foruse in glaucoma management.

Although the precise mechanism is not yet known, recent experimentalresults indicate that the prostaglandin-induced reduction in intraocularpressure results from increased uveoscleral outflow [Nilsson et al.,Invest. Ophthalmol. Vis. Sci. 28(suppl), 284 (1987)].

The isopropyl ester of PGF_(2α) has been shown to have significantlygreater hypotensive potency than the parent compound, which wasattributed to its more effective penetration through the cornea. In1987, this compound was described as “the most potent ocular hypotensiveagent ever reported.” [See, for example, Bito, L. Z., Arch. Ophthalmol.105, 1036 (1987), and Siebold et al., Prodrug 5, 3 (1989)].

Whereas prostaglandins appear to be devoid of significant intraocularside effects, ocular surface (conjunctival) hyperemia and foreign-bodysensation have been consistently associated with the topical ocular useof such compounds, in particular PGF_(2α) and its prodrugs, e.g. its1-isopropyl ester, in humans. The clinical potential of prostaglandinsin the management of conditions associated with increased ocularpressure, e.g. glaucoma, is greatly limited by these side effects.

Certain prostaglandins and their analogs and derivatives, such as thePGF_(2α) derivative latanoprost, sold under the trademark Xalatan®, havebeen established as compounds useful in treating ocular hypertension andglaucoma. However, latanoprost, the first prostaglandin approved by theUnited States Food And Drug Administration for this indication, is aprostaglandin derivative possessing the undesirable side effect ofproducing an increase in brown pigment in the iris of 5-15% of humaneyes. The change in color results from an increased number ofmelanosomes (pigment granules) within iridial melanocytes. See e.g.,Watson et al., Ophthalmology 103:126 (1996). While it is still unclearwhether this effect has additional and deleterious clinicalramifications, from a cosmetic standpoint alone such side effects areundesirable.

Certain phenyl and phenoxy mono, tri and tetra nor prostaglandins andtheir 1-esters are disclosed in European Patent Application 0,364,417 asuseful in the treatment of glaucoma or ocular hypertension.

In a series of United States patent applications assigned to Allergan,Inc. prostaglandin esters with increased ocular hypotensive activityaccompanied with no or substantially reduced side-effects are disclosed.U.S. patent application Ser. No. 386,835 (filed Jul. 27, 1989), relatesto certain 11-acyl-prostaglandins, such as 11-pivaloyl, 11-acetyl,11-isobutyryl, 11-valeryl, and 11-isovaleryl PGF_(2α). Intraocularpressure reducing 15-acyl prostaglandins are disclosed in U.S. Ser. No.357,394 (filed May 25, 1989). Similarly, 11,15-9,15- and 9,11-diestersof prostaglandins, for example 11,15-dipivaloyl PGF_(2α) are known tohave ocular hypotensive activity. See U.S. Ser. No. 385,645 filed Jul.27, 1990, now U.S. Pat. Nos. 4,494,274; 584,370 which is a continuationof U.S. Ser. No. 386,312, and U.S. Ser. No. 585,284, now U.S. Pat. No.5,034,413 which is a continuation of U.S. Ser. No. 386,834, where theparent applications were filed on Jul. 27, 1989.

Woodward et al U.S. Pat. Nos. 5,688,819 and 6,403,649 disclose certaincyclopentane heptanoic acid, 2-cycloalkyl or arylalkyl compounds asocular hypotensives. These compounds, which can properly becharacterized as hypotensive lipids, are effective in treating ocularhypertension.

As one example, the prostamide analog, bimatoprost, has been discoveredto be effective in reducing intraocular pressure possibly by increasingthe aqueous humour outflow of an eye (Woodward et al., AGN 192024(Lumigano®): A Synthetic Prostamide Analog that Lowers PrimateIntraocular Pressure by Virtue of Its Inherent Pharmacological Activity,ARVO 2002; (CD-ROM):POS; Chen et al., Lumigan®: A Novel Drug forGlaucoma Therapy, Optom In Pract, 3:95-102 (2002); Coleman et al., A3-Month Randomized Controlled Trial of Bimatoprost (LUMIGAN) versusCombined Timolol and Dorzolamide (Cosopt) in Patients with Glaucoma orOcular Hypertension, Ophthalmology 110(12): 2362-8 (2003); Brubaker,Mechanism of Action of Bimatoprost (Lumigan™), Surv Ophthalmol 45 (Suppl4):S347-S351 (2001); and Woodward et al., The Pharmacology ofBimatoprost (Lumigan™), Surv Ophthalmol 45 (Suppl 4) S337-S345 (2001).

Bimatoprost is an analog (e.g., a structural derivative) of a naturallyoccurring prostamide. Bimatoprost's chemical name is(Z)-7-[(1R,2R,3R,5S)-3,5-Dihydroxy-2-[1E,3S)-3-hydroxy-5-phenyl-1-pentenyl]cyclopentyl]-5-N-ethylheptenamide,and it has a molecular weight of 415.58. It's molecular formula isC₂₅H₃₇NO₄. Bimatoprost is available in a topical ophthalmic solutionunder the tradename Lumigan® (Allergan, Inc.). Each mL of the solutioncontains 0.3 mg of bimatoprost as the active agent, 0.05 mg ofbenzalkonium chloride (BAK) as a preservative, and sodium chloride,sodium phosphate, dibasic; citric acid; and purified water as inactiveagents.

Biocompatible implants for placement in the eye have been disclosed in anumber of patents, such as U.S. Pat. Nos. 4,521,210; 4,853,224;4,997,652; 5,164,188; 5,443,505; 5,501,856; 5,766,242; 5,824,072;5,869,079; 6,074,661; 6,331,313; 6,369,116; and 6,699,493.

It would be advantageous to provide eye implantable drug deliverysystems, such as intraocular implants, and methods of using suchsystems, that are capable of releasing a therapeutic agent, such as ahypotensive agent, at a sustained or controlled rate for extendedperiods of time and in amounts with few or no negative side effects.

SUMMARY

The present invention provides new drug delivery systems, and methods ofmaking and using such systems, for extended or sustained drug releaseinto an eye, for example, to achieve one or more desired therapeuticeffects. The drug delivery systems are in the form of implants orimplant elements that may be placed in an eye. The present systems andmethods advantageously provide for extended release times of one or moretherapeutic agents. Thus, the patient in whose eye the implant has beenplaced receives a therapeutic amount of an agent for a long or extendedtime period without requiring additional administrations of the agent.For example, the patient has a substantially consistent level oftherapeutically active agent available for consistent treatment of theeye over a relatively long period of time, for example, on the order ofat least about one week, such as between about two and about six monthsafter receiving an implant. Such extended release times facilitateobtaining successful treatment results.

Intraocular implants in accordance with the disclosure herein comprise atherapeutic component and a drug release sustaining component associatedwith the therapeutic component. In accordance with the presentinvention, the therapeutic component comprises, consists essentially of,or consists of, a prostamide component, such as a prostamide derivativethat is effective in reducing or maintaining a reduced intraocularpressure in a hypertensive eye. The drug release sustaining component isassociated with the therapeutic component to sustain release of anamount of the prostamide component into an eye in which the implant isplaced. The amount of the prostamide component is released into the eyefor a period of time greater than about one week after the implant isplaced in the eye and is effective in treating or reducing at least onesymptom of an ocular condition of an eye. Advantageously, the presentintraocular implants may be effective in relieving a hypertensive eye byreducing the intraocular pressure of the eye or maintaining theintraocular pressure at a reduced level.

In one embodiment, the intraocular implants comprise prostamidecomponent and a biodegradable polymer matrix. The prostamide componentis associated with a biodegradable polymer matrix that releases drug ata rate effective to sustain release of an amount of the prostamidecomponent from the implant effective to treat an ocular condition. Theintraocular implant is biodegradable or bioerodible and provides asustained release of the prostamide component in an eye for extendedperiods of time, such as for more than one week, for example for aboutthree months or more and up to about six months or more.

The biodegradable polymer component of the foregoing implants may be amixture of biodegradable polymers, wherein at least one of thebiodegradable polymers is a polylactic acid polymer having a molecularweight less than 64 kiloDaltons (kD). Additionally or alternatively, theforegoing implants may comprise a first biodegradable polymer of apolylactic acid, and a different second biodegradable polymer of apolylactic acid. Furthermore, the foregoing implants may comprise amixture of different biodegradable polymers, each biodegradable polymerhaving an inherent viscosity in a range of about 0.2 deciliters/gram(dl/g) to about 1.0 dl/g.

The prostamide component of the implants disclosed herein may includeprostamide derivatives, such as a prostamide analog, that are effectivein treating ocular conditions. One example of a suitable prostamidederivative is bimatoprost or a salt thereof. In addition, thetherapeutic component of the present implants may include one or moreadditional and different therapeutic agents that may be effective intreating an ocular condition.

A method of making the present implants involves combining or mixing theprostamide component with a biodegradable polymer or polymers. Themixture may then be extruded or compressed to form a single composition.The single composition may then be processed to form individual implantssuitable for placement in an eye of a patient.

The implants may be placed in an ocular region to treat a variety ofocular conditions. For example, the implants may be effective inreducing ocular hypertension, and thereby may be effective in reducingat least one symptom of an ocular condition associated with an increasedintraocular pressure.

Kits in accordance with the present invention may comprise one or moreof the present implants, and instructions for using the implants. Forexample, the instructions may explain how to administer the implants toa patient, and types of conditions that may be treated with theimplants.

Each and every feature described herein, and each and every combinationof two or more of such features, is included within the scope of thepresent invention provided that the features included in such acombination are not mutually inconsistent. In addition, any feature orcombination of features may be specifically excluded from any embodimentof the present invention.

Additional aspects and advantages of the present invention are set forthin the following description and claims, particularly when considered inconjunction with the accompanying drawings.

DESCRIPTION

As described herein, controlled and sustained administration of atherapeutic agent through the use of one or more intraocular implantsmay improve treatment of undesirable ocular conditions. The implantscomprise a pharmaceutically acceptable polymeric composition and areformulated to release one or more pharmaceutically active agents, suchas a prostamide, a prostamide derivative, such as a prostamide analog,or other intraocular pressure lowering agent, over an extended period oftime. The implants are effective to provide a therapeutically effectivedosage of the agent or agents directly to a region of the eye to treator prevent one or more undesirable ocular conditions. Thus, with asingle administration, therapeutic agents will be made available at thesite where they are needed and will be maintained for an extended periodof time, rather than subjecting the patient to repeated injections orrepeated administration of topical drops.

An intraocular implant in accordance with the disclosure hereincomprises a therapeutic component and a drug release sustainingcomponent associated with the therapeutic component. In accordance withthe present invention, the therapeutic component comprises, consistsessentially of, or consists of, a prostamide component. The drug releasesustaining component is associated with the therapeutic component tosustain release of an effective amount of the prostamide component intoan eye in which the implant is placed. The amount of the prostamidecomponent is released into the eye for a period of time greater thanabout one week after the implant is placed in the eye, and is effectivein treating or reducing a symptom of an ocular condition.

Definitions

For the purposes of this description, we use the following terms asdefined in this section, unless the context of the word indicates adifferent meaning.

As used herein, an “intraocular implant” refers to a device or elementthat is structured, sized, or otherwise configured to be placed in aneye. Intraocular implants are generally biocompatible with physiologicalconditions of an eye and do not cause adverse side effects. Intraocularimplants may be placed in an eye without disrupting vision of the eye.

As used herein, a “therapeutic component” refers to a portion of anintraocular implant comprising one or more therapeutic agents orsubstances used to treat a medical condition of the eye. The therapeuticcomponent may be a discrete region of an intraocular implant, or it maybe homogenously distributed throughout the implant. The therapeuticagents of the therapeutic component are typically ophthalmicallyacceptable, and are provided in a form that does not cause adversereactions when the implant is placed in an eye.

As used herein, a “prostamide component” refers to a portion of anintraocular implant that comprises one or more prostamides, one or moreprostamide derivatives, such as a prostamide analog, salts thereof, andmixtures thereof. A prostamide derivative is a compound that containsthe essential elements of the prostamide from which it is derived inorder to provide a therapeutic effect. A prostamide derivative includesprostamide analogs, and can be identified using any conventional methodsknown by persons of ordinary skill in the art used to evaluate theefficacy of a prostamide. For example, therapeutically effectiveprostamide derivatives can be identified by applying the prostamidederivative to an eye with increased intraocular pressure, and evaluatingwhether the intraocular pressure decreases after the application. Aprostamide component may also include one or more prostaglandin analogs.

As used herein, a “drug release sustaining component” refers to aportion of the intraocular implant that is effective to provide asustained release of the therapeutic agents of the implant. A drugrelease sustaining component may be a biodegradable polymer matrix, orit may be a coating covering a core region of the implant that comprisesa therapeutic component.

As used herein, “associated with” means mixed with, dispersed within,coupled to, covering, or surrounding.

As used herein, an “ocular region” or “ocular site” refers generally toany area of the eyeball, including the anterior and posterior segment ofthe eye, and which generally includes, but is not limited to, anyfunctional (e.g., for vision) or structural tissues found in theeyeball, or tissues or cellular layers that partly or completely linethe interior or exterior of the eyeball. Specific examples of areas ofthe eyeball in an ocular region include the anterior chamber, theposterior chamber, the vitreous cavity, the choroid, the suprachoroidalspace, the conjunctiva, the subconjunctival space, the episcleral space,the intracorneal space, the epicorneal space, the sclera, the parsplana, surgically-induced avascular regions, the macula, and the retina.

As used herein, an “ocular condition” is a disease, ailment or conditionwhich affects or involves the eye or one of the parts or regions of theeye. Broadly speaking the eye includes the eyeball and the tissues andfluids which constitute the eyeball, the periocular muscles (such as theoblique and rectus muscles) and the portion of the optic nerve which iswithin or adjacent to the eyeball.

An anterior ocular condition is a disease, ailment or condition whichaffects or which involves an anterior (i.e. front of the eye) ocularregion or site, such as a periocular muscle, an eye lid or an eye balltissue or fluid which is located anterior to the posterior wall of thelens capsule or ciliary muscles. Thus, an anterior ocular conditionprimarily affects or involves the conjunctiva, the cornea, the anteriorchamber, the iris, the posterior chamber (behind the retina but in frontof the posterior wall of the lens capsule), the lens or the lens capsuleand blood vessels and nerve which vascularize or innervate an anteriorocular region or site.

Thus, an anterior ocular condition can include a disease, ailment orcondition, such as for example, aphakia; pseudophakia; astigmatism;blepharospasm; cataract; conjunctival diseases; conjunctivitis; cornealdiseases; corneal ulcer; dry eye syndromes; eyelid diseases; lacrimalapparatus diseases; lacrimal duct obstruction; myopia; presbyopia; pupildisorders; refractive disorders and strabismus. Glaucoma can also beconsidered to be an anterior ocular condition because a clinical goal ofglaucoma treatment can be to reduce a hypertension of aqueous fluid inthe anterior chamber of the eye (i.e. reduce intraocular pressure).

A posterior ocular condition is a disease, ailment or condition whichprimarily affects or involves a posterior ocular region or site such aschoroid or sclera (in a position posterior to a plane through theposterior wall of the lens capsule), vitreous, vitreous chamber, retina,optic nerve (i.e. the optic disc), and blood vessels and nerves whichvascularize or innervate a posterior ocular region or site.

Thus, a posterior ocular condition can include a disease, ailment orcondition, such as for example, acute macular neuroretinopathy; Behcet'sdisease; choroidal neovascularization; diabetic uveitis; histoplasmosis;infections, such as fungal or viral-caused infections; maculardegeneration, such as acute macular degeneration, non-exudative agerelated macular degeneration and exudative age related maculardegeneration; edema, such as macular edema, cystoid macular edema anddiabetic macular edema; multifocal choroiditis; ocular trauma whichaffects a posterior ocular site or location; ocular tumors; retinaldisorders, such as central retinal vein occlusion, diabetic retinopathy(including proliferative diabetic retinopathy), proliferativevitreoretinopathy (PVR), retinal arterial occlusive disease, retinaldetachment, uveitic retinal disease; sympathetic opthalmia; VogtKoyanagi-Harada (VKH) syndrome; uveal diffusion; a posterior ocularcondition caused by or influenced by an ocular laser treatment;posterior ocular conditions caused by or influenced by a photodynamictherapy, photocoagulation, radiation retinopathy, epiretinal membranedisorders, branch retinal vein occlusion, anterior ischemic opticneuropathy, non-retinopathy diabetic retinal dysfunction, retinitispigmentosa, and glaucoma. Glaucoma can be considered a posterior ocularcondition because the therapeutic goal is to prevent the loss of orreduce the occurrence of loss of vision due to damage to or loss ofretinal cells or optic nerve cells (i.e. neuroprotection).

The term “biodegradable polymer” refers to a polymer or polymers whichdegrade in vivo, and wherein erosion of the polymer or polymers overtime occurs concurrent with or subsequent to release of the therapeuticagent. Specifically, hydrogels such as methylcellulose which act torelease drug through polymer swelling are specifically excluded from theterm “biodegradable polymer”. The terms “biodegradable” and“bioerodible” are equivalent and are used interchangeably herein. Abiodegradable polymer may be a homopolymer, a copolymer, or a polymercomprising more than two different polymeric units.

The term “treat”, “treating”, or “treatment” as used herein, refers toreduction or resolution or prevention of an ocular condition, ocularinjury or damage, or to promote healing of injured or damaged oculartissue. A treatment is usually effective to reduce at least one symptomof an ocular condition, ocular injury or damage.

The term “therapeutically effective amount” as used herein, refers tothe level or amount of agent needed to treat an ocular condition, orreduce or prevent ocular injury or damage without causing significantnegative or adverse side effects to the eye or a region of the eye. Inview of the above, a therapeutically effective amount of a therapeuticagent, such as a prostamide or prostamide derivative, is an amount thatis effective in reducing at least one symptom of an ocular condition.

Intraocular implants have been developed which can release drug loadsover various time periods. These implants, which when inserted into aneye, such as the vitreous of an eye, provide therapeutic levels of aprostamide component for extended periods of time (e.g., for about 1week or more). The disclosed implants are effective in treating ocularconditions, such as ocular conditions associated with elevatedintraocular pressure, and more specifically in reducing at least onesymptom of glaucoma.

In one embodiment of the present invention, an intraocular implantcomprises a biodegradable polymer matrix. The biodegradable polymermatrix is one type of a drug release sustaining component. Thebiodegradable polymer matrix is effective in forming a biodegradableintraocular implant. The biodegradable intraocular implant comprises aprostamide component associated with the biodegradable polymer matrix.The matrix degrades at a rate effective to sustain release of an amountof the prostamide component for a time greater than about one week fromthe time in which the implant is placed in ocular region or ocular site,such as the vitreous of an eye.

The prostamide component of the implant includes one or more types ofprostamides, prostamide derivatives, salts thereof, and mixturesthereof. In certain implants, the prostamide component comprises acompound having the formula (I)

wherein the dashed bonds represent a single or double bond which can bein the cis or trans configuration, A is an alkylene or alkenyleneradical having from two to six carbon atoms, which radical may beinterrupted by one or more oxide radicals and substituted with one ormore hydroxy, oxo, alkyloxy or alkylcarboxy groups wherein said alkylradical comprises from one to six carbon atoms; B is a cycloalkylradical having from three to seven carbon atoms, or an aryl radical,selected from the group consisting of hydrocarbyl aryl and heteroarylradicals having from four to ten carbon atoms wherein the heteroatom isselected from the group consisting of nitrogen, oxygen and sulfur atoms;X is a radical selected from the group consisting of —OR⁴ and —N(R⁴)₂wherein R⁴ is selected from the group consisting of hydrogen, a loweralkyl radical having from one to six carbon atoms,

wherein R⁵ is a lower alkyl radical having from one to six carbon atoms;Z is ═O or represents 2 hydrogen radicals; one of R₁ and R₂ is ═O, —OHor a —O(CO)R₆ group, and the other one is —OH or —O(CO)R₆, or R₁ is ═Oand R₂ is H, wherein R₆ is a saturated or unsaturated acyclichydrocarbon group having from 1 to about 20 carbon atoms, or —(CH₂)mR₇wherein m is 0 or an integer of from 1 to 10, and R₇ is cycloalkylradical, having from three to seven carbon atoms, or a hydrocarbyl arylor heteroaryl radical, as defined above, or apharmaceutically-acceptable salt thereof, provided, however, that when Bis not substituted with a pendant heteroatom-containing radical, and Zis ═O, then X is not —OR⁴.

Pharmaceutically acceptable acid addition salts of the compounds of theinvention are those formed from acids which form non-toxic additionsalts containing pharmaceutically acceptable anions, such as thehydrochloride, hydrobromide, hydroiodide, sulfate, or bisulfate,phosphate or acid phosphate, acetate, maleate, fumarate, oxalate,lactate, tartrate, citrate, gluconate, saccharate and p-toluenesulphonate salts.

In more specific implants, the compound of the prostamide component hasthe following formula (II)

wherein y is 0 or 1, x is 0 or 1 and x+y are not both 1, Y is a radicalselected from the group consisting of alkyl, halo, nitro, amino, thiol,hydroxy, alkyloxy, alkylcarboxy and halo substituted alkyl, wherein saidalkyl radical comprises from one to six carbon atoms, n is 0 or aninteger of from 1 to 3 and R₃ is ═O, —OH or —O(CO)R₆.

In additional implants, the compound of the prostamide component has thefollowing formula (III)

wherein hatched lines indicate the α configuration and solid trianglesindicate the β configuration.

In certain implants, the compound of the prostamide component has thefollowing formula (IV)

wherein Y¹ is Cl or trifluoromethyl, such as the compound having thefollowing formula (V)

and the 9- and/or 11- and/or 15 esters thereof.

In at least one type of intraocular implant, the prostamide componentcomprises a compound having the following formula (VI)

The compound having the formula VI is also known as bimatoprost and ispublicly available in a topical ophthalmic solution under the tradename,Lumigan® (Allergan, Inc., CA).

Thus, the implant may comprise a therapeutic component which comprises,consists essentially of, or consists of bimatoprost, a salt thereof, ormixtures thereof.

The prostamide component may be in a particulate or powder form and itmay be entrapped by the biodegradable polymer matrix. Usually,prostamide particles will have an effective average size less than about3000 nanometers. In certain implants, the particles may have aneffective average particle size about an order of magnitude smaller than3000 nanometers. For example, the particles may have an effectiveaverage particle size of less than about 500 nanometers. In additionalimplants, the particles may have an effective average particle size ofless than about 400 nanometers, and in still further embodiments, a sizeless than about 200 nanometers.

The prostamide component of the implant is preferably from about 10% to90% by weight of the implant. More preferably, the prostamide componentis from about 20% to about 80% by weight of the implant. In a preferredembodiment, the prostamide component comprises about 20% by weight ofthe implant (e.g., 15%-25%). In another embodiment, the prostamidecomponent comprises about 50% by weight of the implant.

Suitable polymeric materials or compositions for use in the implantinclude those materials which are compatible, that is biocompatible,with the eye so as to cause no substantial interference with thefunctioning or physiology of the eye. Such materials preferably are atleast partially and more preferably substantially completelybiodegradable or bioerodible.

Examples of useful polymeric materials include, without limitation, suchmaterials derived from and/or including organic esters and organicethers, which when degraded result in physiologically acceptabledegradation products, including the monomers. Also, polymeric materialsderived from and/or including, anhydrides, amides, orthoesters and thelike, by themselves or in combination with other monomers, may also finduse. The polymeric materials may be addition or condensation polymers,advantageously condensation polymers. The polymeric materials may becross-linked or non-cross-linked, for example not more than lightlycross-linked, such as less than about 5%, or less than about 1% of thepolymeric material being cross-linked. For the most part, besides carbonand hydrogen, the polymers will include at least one of oxygen andnitrogen, advantageously oxygen. The oxygen may be present as oxy, e.g.hydroxy or ether, carbonyl, e.g. non-oxo-carbonyl, such as carboxylicacid ester, and the like. The nitrogen may be present as amide, cyanoand amino. The polymers set forth in Heller, Biodegradable Polymers inControlled Drug Delivery, In: CRC Critical Reviews in Therapeutic DrugCarrier Systems, Vol. 1, CRC Press, Boca Raton, Fla. 1987, pp 39-90,which describes encapsulation for controlled drug delivery, may find usein the present implants.

Of additional interest are polymers of hydroxyaliphatic carboxylicacids, either homopolymers or copolymers, and polysaccharides.Polyesters of interest include polymers of D-lactic acid, L-lactic acid,racemic lactic acid, glycolic acid, polycaprolactone, and combinationsthereof. Generally, by employing the L-lactate or D-lactate, a slowlyeroding polymer or polymeric material is achieved, while erosion issubstantially enhanced with the lactate racemate.

Among the useful polysaccharides are, without limitation, calciumalginate, and functionalized celluloses, particularlycarboxymethylcellulose esters characterized by being water insoluble, amolecular weight of about 5 kD to 500 kD, for example.

Other polymers of interest include, without limitation, polyvinylalcohol, polyesters, polyethers and combinations thereof which arebiocompatible and may be biodegradable and/or bioerodible.

Some preferred characteristics of the polymers or polymeric materialsfor use in the present invention may include biocompatibility,compatibility with the therapeutic component, ease of use of the polymerin making the drug delivery systems of the present invention, ahalf-life in the physiological environment of at least about 6 hours,preferably greater than about one day, not significantly increasing theviscosity of the vitreous, and water insolubility.

The biodegradable polymeric materials which are included to form thematrix are desirably subject to enzymatic or hydrolytic instability.Water soluble polymers may be cross-linked with hydrolytic orbiodegradable unstable cross-links to provide useful water insolublepolymers. The degree of stability can be varied widely, depending uponthe choice of monomer, whether a homopolymer or copolymer is employed,employing mixtures of polymers, and whether the polymer includesterminal acid groups.

Equally important to controlling the biodegradation of the polymer andhence the extended release profile of the implant is the relativeaverage molecular weight of the polymeric composition employed in theimplant. Different molecular weights of the same or different polymericcompositions may be included in the implant to modulate the releaseprofile. In certain implants, the relative average molecular weight ofthe polymer will range from about 9 to about 64 kD, usually from about10 to about 54 kD, and more usually from about 12 to about 45 kD.

In some implants, copolymers of glycolic acid and lactic acid are used,where the rate of biodegradation is controlled by the ratio of glycolicacid to lactic acid. The most rapidly degraded copolymer has roughlyequal amounts of glycolic acid and lactic acid. Homopolymers, orcopolymers having ratios other than equal, are more resistant todegradation. The ratio of glycolic acid to lactic acid will also affectthe brittleness of the implant, where a more flexible implant isdesirable for larger geometries. The % of polylactic acid in thepolylactic acid polyglycolic acid (PLGA) copolymer can be 0-100%,preferably about 15-85%, more preferably about 35-65%. In some implants,a 50/50 PLGA copolymer is used.

The biodegradable polymer matrix of the intraocular implant may comprisea mixture of two or more biodegradable polymers. For example, theimplant may comprise a mixture of a first biodegradable polymer and adifferent second biodegradable polymer. One or more of the biodegradablepolymers may have terminal acid groups.

Release of a drug from an erodible polymer is the consequence of severalmechanisms or combinations of mechanisms. Some of these mechanismsinclude desorption from the implant's surface, dissolution, diffusionthrough porous channels of the hydrated polymer and erosion. Erosion canbe bulk or surface or a combination of both. As discussed herein, thematrix of the intraocular implant may release drug at a rate effectiveto sustain release of an amount of the prostamide component for morethan one week after implantation into an eye. In certain implants,therapeutic amounts of the prostamide component are released for no morethan about 30-35 days after implantation. For example, an implant maycomprise bimatoprost, and the matrix of the implant degrades at a rateeffective to sustain release of a therapeutically effective amount ofbimatoprost for about one month after being placed in an eye. As anotherexample, the implant may comprise bimatoprost, and the matrix releasesdrug at a rate effective to sustain release of a therapeuticallyeffective amount of bimatoprost for more than forty days, such as forabout six months.

One example of the biodegradable intraocular implant comprises anprostamide component associated with a biodegradable polymer matrix,which comprises a mixture of different biodegradable polymers. At leastone of the biodegradable polymers is a polylactide having a molecularweight of about 63.3 kD. A second biodegradable polymer is a polylactidehaving a molecular weight of about 14 kD. Such a mixture is effective insustaining release of a therapeutically effective amount of theprostamide component for a time period greater than about one month fromthe time the implant is placed in an eye.

Another example of a biodegradable intraocular implant comprises anprostamide component associated with a biodegradable polymer matrix,which comprises a mixture of different biodegradable polymers, eachbiodegradable polymer having an inherent viscosity from about 0.16 dl/gto about 1.0 dl/g. For example, one of the biodegradable polymers mayhave an inherent viscosity of about 0.3 dl/g. A second biodegradablepolymer may have an inherent viscosity of about 1.0 dl/g. Additionalimplants may comprise biodegradable polymers that have an inherentviscosity between about 0.2 dl/g and 0.5 dl/g. The inherent viscositiesidentified above may be determined in 0.1% chloroform at 25° C.

One particular implant comprises bimatoprost associated with acombination of two different polylactide polymers. The bimatoprost ispresent in about 20% by weight of the implant. One polylactide polymerhas a molecular weight of about 14 kD and an inherent viscosity of about0.3 dl/g, and the other polylactide polymer has a molecular weight ofabout 63.3 kD and an inherent viscosity of about 1.0 dl/g. The twopolylactide polymers are present in the implant in a 1:1 ratio. Such animplant may be effective in releasing the bimatoprost for more than twomonths. The implant is provided in the form of a rod or a filamentproduced by an extrusion process.

The release of the prostamide component from the intraocular implantcomprising a biodegradable polymer matrix may include an initial burstof release followed by a gradual increase in the amount of theprostamide component released, or the release may include an initialdelay in release of the prostamide component followed by an increase inrelease. When the implant is substantially completely degraded, thepercent of the prostamide component that has been released is about onehundred. Compared to existing implants, the implants disclosed herein donot completely release, or release about 100% of the prostamidecomponent, until after about one week of being placed in an eye.

It may be desirable to provide a relatively constant rate of release ofthe prostamide component from the implant over the life of the implant.For example, it may be desirable for the prostamide component to bereleased in amounts from about 0.01 μg to about 2 μg per day for thelife of the implant. However, the release rate may change to eitherincrease or decrease depending on the formulation of the biodegradablepolymer matrix. In addition, the release profile of the prostamidecomponent may include one or more linear portions and/or one or morenon-linear portions. Preferably, the release rate is greater than zeroonce the implant has begun to degrade or erode.

The implants may be monolithic, i.e. having the active agent or agentshomogenously distributed through the polymeric matrix, or encapsulated,where a reservoir of active agent is encapsulated by the polymericmatrix. Due to ease of manufacture, monolithic implants are usuallypreferred over encapsulated forms. However, the greater control affordedby the encapsulated, reservoir-type implant may be of benefit in somecircumstances, where the therapeutic level of the drug falls within anarrow window. In addition, the therapeutic component, including theprostamide component, may be distributed in a non-homogenous pattern inthe matrix. For example, the implant may include a portion that has agreater concentration of the prostamide component relative to a secondportion of the implant.

The intraocular implants disclosed herein may have a size of betweenabout 5 μm and about 10 mm, or between about 10 μm and about 1 mm foradministration with a needle, greater than 1 mm, or greater than 2 mm,such as 3 mm or up to 10 mm, for administration by surgicalimplantation. For needle-injected implants, the implants may have anyappropriate length so long as the diameter of the implant permits theimplant to move through a needle. For example, implants having a lengthof about 6 mm to about 7 mm have been injected into an eye. The implantsadministered by way of a needle should have a diameter that is less thanthe inner diameter of the needle. In certain implants, the diameter isless than about 500 μm. The vitreous chamber in humans is able toaccommodate relatively large implants of varying geometries, havinglengths of, for example, 1 to 10 mm. The implant may be a cylindricalpellet (e. g., rod) with dimensions of about 2 mm×0.75 mm diameter. Orthe implant may be a cylindrical pellet with a length of about 7 mm toabout 10 mm, and a diameter of about 0.75 mm to about 1.5 mm.

The implants may also be at least somewhat flexible so as to facilitateboth insertion of the implant in the eye, such as in the vitreous, andaccommodation of the implant. The total weight of the implant is usuallyabout 250-5000 μg, more preferably about 500-1000 μg. For example, animplant may be about 500 μg, or about 1000 μg. For non-humanindividuals, the dimensions and total weight of the implant(s) may belarger or smaller, depending on the type of individual. For example,humans have a vitreous volume of approximately 3.8 ml, compared withapproximately 30 ml for horses, and approximately 60-100 ml forelephants. An implant sized for use in a human may be scaled up or downaccordingly for other animals, for example, about 8 times larger for animplant for a horse, or about, for example, 26 times larger for animplant for an elephant.

Thus, implants can be prepared where the center may be of one materialand the surface may have one or more layers of the same or a differentcomposition, where the layers may be cross-linked, or of a differentmolecular weight, different density or porosity, or the like. Forexample, where it is desirable to quickly release an initial bolus ofdrug, the center may be a polylactate coated with apolylactate-polyglycolate copolymer, so as to enhance the rate ofinitial degradation. Alternatively, the center may be polyvinyl alcoholcoated with polylactate, so that upon degradation of the polylactateexterior the center would dissolve and be, rapidly washed out of theeye.

The implants may be of any geometry including fibers, sheets, films,microspheres, spheres, circular discs, plaques and the like. The upperlimit for the implant size will be determined by factors such astoleration for the implant, size limitations on insertion, ease ofhandling, etc. Where sheets or films are employed, the sheets or filmswill be in the range of at least about 0.5 mm×0.5 mm, usually about 3-10mm×5-10 mm with a thickness of about 0.1-1.0 mm for ease of handling.Where fibers are employed, the fiber diameter will generally be in therange of about 0.05 to 3 mm and the fiber length will generally be inthe range of about 0.5-10 mm. Spheres may be in the range of about 0.5μm to 4 mm in diameter, with comparable volumes for other shapedparticles.

The size and form of the implant can also be used to control the rate ofrelease, period of treatment, and drug concentration at the site ofimplantation. Larger implants will deliver a proportionately largerdose, but depending on the surface to mass ratio, may have a slowerrelease rate. The particular size and geometry of the implant are chosento suit the site of implantation.

The proportions of the prostamide component, polymer, and any othermodifiers may be empirically determined by formulating several implantswith varying proportions. A USP approved method for dissolution orrelease test can be used to measure the rate of release (USP 23; NF 18(1995) pp. 1790-1798). For example, using the infinite sink method, aweighed sample of the implant is added to a measured volume of asolution containing 0.9% NaCl in water, where the solution volume willbe such that the drug concentration is after release is less than 5% ofsaturation. The mixture is maintained at 37° C. and stirred slowly tomaintain the implants in suspension. The appearance of the dissolveddrug as a function of time may be followed by various methods known inthe art, such as spectrophotometrically, HPLC, mass spectroscopy, etc.until the absorbance becomes constant or until greater than 90% of thedrug has been released.

In addition to the prostamide or prostamide derivatives included in theintraocular implants disclosed herein, the intraocular implants may alsoinclude one or more additional ophthalmically acceptable therapeuticagents. For example, the implant may include one or more antihistamines,one or more antibiotics, one or more beta blockers, one or moresteroids, one or more antineoplastic agents, one or moreimmunosuppressive agents, one or more antiviral agents, one or moreantioxidant agents, and mixtures thereof.

Pharmacologic or therapeutic agents which may find use in the presentsystems, include, without limitation, those disclosed in U.S. Pat. No.4,474,451, columns 4-6 and U.S. Pat. No. 4,327,725, columns 7-8.

Examples of antihistamines include, and are not limited to, loradatine,hydroxyzine, diphenhydramine, chlorpheniramine, brompheniramine,cyproheptadine, terfenadine, clemastine, triprolidine, carbinoxamine,diphenylpyraline, phenindamine, azatadine, tripelennamine,dexchlorpheniramine, dexbrompheniramine, methdilazine, and trimprazinedoxylamine, pheniramine, pyrilamine, chiorcyclizine, thonzylamine, andderivatives thereof.

Examples of antibiotics include without limitation, cefazolin,cephradine, cefaclor, cephapirin, ceftizoxime, cefoperazone, cefotetan,cefutoxime, cefotaxime, cefadroxil, ceftazidime, cephalexin,cephalothin, cefamandole, cefoxitin, cefonicid, ceforanide, ceftriaxone,cefadroxil, cephradine, cefuroxime, ampicillin, amoxicillin,cyclacillin, ampicillin, penicillin G, penicillin V potassium,piperacillin, oxacillin, bacampicillin, cloxacillin, ticarcillin,azlocillin, carbenicillin, methicillin, nafcillin, erythromycin,tetracycline, doxycycline, minocycline, aztreonam, chloramphenicol,ciprofloxacin hydrochloride, clindamycin, metronidazole, gentamicin,lincomycin, tobramycin, vancomycin, polymyxin B sulfate, colistimethate,colistin, azithromycin, augmentin, sulfamethoxazole, trimethoprim, andderivatives thereof.

Examples of beta blockers include acebutolol, atenolol, labetalol,metoprolol, propranolol, timolol, and derivatives thereof.

Examples of steroids include corticosteroids, such as cortisone,prednisolone, flurometholone, dexamethasone, medrysone, loteprednol,fluazacort, hydrocortisone, prednisone, betamethasone, prednisone,methylprednisolone, riamcinolone hexacatonide, paramethasone acetate,diflorasone, fluocinonide, fluocinolone, triamcinolone, derivativesthereof, and mixtures thereof.

Examples of antineoplastic agents include adriamycin, cyclophosphamide,actinomycin, bleomycin, duanorubicin, doxorubicin, epirubicin,mitomycin, methotrexate, fluorouracil, carboplatin, carmustine (BCNU),methyl-CCNU, cisplatin, etoposide, interferons, camptothecin andderivatives thereof, phenesterine, taxol and derivatives thereof,taxotere and derivatives thereof, vinblastine, vincristine, tamoxifen,etoposide, piposulfan, cyclophosphamide, and flutamide, and derivativesthereof.

Examples of immunosuppresive agents include cyclosporine, azathioprine,tacrolimus, and derivatives thereof.

Examples of antiviral agents include interferon gamma, zidovudine,amantadine hydrochloride, ribavirin, acyclovir, valciclovir,dideoxycytidine, phosphonoformic acid, ganciclovir, and derivativesthereof.

Examples of antioxidant agents include ascorbate, alpha-tocopherol,mannitol, reduced glutathione, various carotenoids, cysteine, uric acid,taurine, tyrosine, superoxide dismutase, lutein, zeaxanthin,cryotpxanthin, astazanthin, lycopene, N-acetyl-cysteine, carnosine,gamma-glutamylcysteine, quercitin, lactoferrin, dihydrolipoic acid,citrate, Ginkgo Biloba extract, tea catechins, bilberry extract,vitamins E or esters of vitamin E, retinyl palmitate, and derivativesthereof.

Other therapeutic agents include squalamine, carbonic anhydraseinhibitors, alpha-2 adrenergic receptor agonists, antiparasitics,antifungals, and derivatives thereof.

The amount of active agent or agents employed in the implant,individually or in combination, will vary widely depending on theeffective dosage required and the desired rate of release from theimplant. Usually the agent will be at least about 1, more usually atleast about 10 weight percent of the implant, and usually not more thanabout 80, more usually not more than about 40 weight percent of theimplant.

Some of the present implants may comprise a prostamide component thatcomprises a combination of two or more different prostamide derivatives.One implant may comprise a combination of bimatoprost and latanoprost.Another implant may comprise a combination of bimatoprost andtravoprost.

As discussed herein, the present implants may comprise additionaltherapeutic agents. For example, one implant may comprise a combinationof bimatoprost and a beta-adrenergic receptor antagonist. Morespecifically, the implant may comprise a combination of bimatoprost andTimolol®. Or, an implant may comprise a combination of bimatoprost and acarbonic anyhdrase inhibitor. For example, the implant may comprise acombination of bimatoprost and dorzolamide (Trusopt®).

In addition to the therapeutic component, the intraocular implantsdisclosed herein may include effective amounts of buffering agents,preservatives and the like. Suitable water soluble buffering agentsinclude, without limitation, alkali and alkaline earth carbonates,phosphates, bicarbonates, citrates, borates, acetates, succinates andthe like, such as sodium phosphate, citrate, borate, acetate,bicarbonate, carbonate and the like. These agents advantageously presentin amounts sufficient to maintain a pH of the system of between about 2to about 9 and more preferably about 4 to about 8. As such the bufferingagent may be as much as about 5% by weight of the total implant.Suitable water soluble preservatives include sodium bisulfite, sodiumbisulfate, sodium thiosulfate, ascorbate, benzalkonium chloride,chlorobutanol, thimerosal, phenylmercuric acetate, phenylmercuricborate, phenylmercuric nitrate, parabens, methylparaben, polyvinylalcohol, benzyl alcohol, phenylethanol and the like and mixturesthereof. These agents may be present in amounts of from 0.001 to about5% by weight and preferably 0.01 to about 2% by weight. In at least oneof the present implants, a benzylalkonium chloride preservative isprovided in the implant, such as when the prostamide component consistsessentially of bimatoprost.

In some situations mixtures of implants may be utilized employing thesame or different pharmacological agents. In this way, a cocktail ofrelease profiles, giving a biphasic or triphasic release with a singleadministration is achieved, where the pattern of release may be greatlyvaried.

Additionally, release modulators such as those described in U.S. Pat.No. 5,869,079 may be included in the implants. The amount of releasemodulator employed will be dependent on the desired release profile, theactivity of the modulator, and on the release profile of the prostamidecomponent in the absence of modulator. Electrolytes such as sodiumchloride and potassium chloride may also be included in the implant.Where the buffering agent or enhancer is hydrophilic, it may also act asa release accelerator. Hydrophilic additives act to increase the releaserates through faster dissolution of the material surrounding the drugparticles, which increases the surface area of the drug exposed, therebyincreasing the rate of drug bioerosion. Similarly, a hydrophobicbuffering agent or enhancer dissolve more slowly, slowing the exposureof drug particles, and thereby slowing the rate of drug bioerosion.

In certain implants, an implant comprising bimatoprost and abiodegradable polymer matrix is able to release or deliver an amount ofbimatoprost between about 0.1 mg to about 0.5 mg for about 3-6 monthsafter implantation into the eye. The implant may be configured as a rodor a wafer. A rod-shaped implant may be derived from filaments extrudedfrom a 720 μm nozzle and cut into 1 mg size. A wafer-shaped implant maybe a circular disc having a diameter of about 2.5 mm, a thickness ofabout 0.127 mm, and a weight of about 1 mg.

Various techniques may be employed to produce the implants describedherein. Useful techniques include, but are not necessarily limited to,solvent evaporation methods, phase separation methods, interfacialmethods, molding methods, injection molding methods, extrusion methods,co-extrusion methods, carver press method, die cutting methods, heatcompression, combinations thereof and the like.

Specific methods are discussed in U.S. Pat. No. 4,997,652. Extrusionmethods may be used to avoid the need for solvents in manufacturing.When using extrusion methods, the polymer and drug are chosen so as tobe stable at the temperatures required for manufacturing, usually atleast about 85 degrees Celsius. Extrusion methods use temperatures ofabout 25 degrees C. to about 150 degrees C., more preferably about 65degrees C. to about 130 degrees C. An implant may be produced bybringing the temperature to about 60 degrees C. to about 150 degrees C.for drug/polymer mixing, such as about 130 degrees C., for a time periodof about 0 to 1 hour, 0 to 30 minutes, or 5-15 minutes. For example, atime period may be about 10 minutes, preferably about 0 to 5 min. Theimplants are then extruded at a temperature of about 60 degrees C. toabout 130 degrees C., such as about 75 degrees C.

In addition, the implant may be coextruded so that a coating is formedover a core region during the manufacture of the implant.

Compression methods may be used to make the implants, and typicallyyield implants with faster release rates than extrusion methods.Compression methods may use pressures of about 50-150 psi, morepreferably about 70-80 psi, even more preferably about 76 psi, and usetemperatures of about 0 degrees C. to about 115 degrees C., morepreferably about 25 degrees C.

The implants of the present invention may be inserted into the eye, forexample the vitreous chamber of the eye, by a variety of methods,including placement by forceps or by trocar following making a 2-3 mmincision in the sclera. One example of a device that may be used toinsert the implants into an eye is disclosed in U.S. patent PublicationNo. 2004/0054374. The method of placement may influence the therapeuticcomponent or drug release kinetics. For example, delivering the implantwith a trocar may result in placement of the implant deeper within thevitreous than placement by forceps, which may result in the implantbeing closer to the edge of the vitreous. The location of the implantmay influence the concentration gradients of therapeutic component ordrug surrounding the element, and thus influence the release rates(e.g., an element placed closer to the edge of the vitreous may resultin a slower release rate).

The present implants are configured to release an amount of prostamidecomponent effective to treat an ocular condition, such as by reducing atleast one symptom of the ocular condition. More specifically, theimplants may be used in a method to treat glaucoma, such as open angleglaucoma, ocular hypertension, chronic angle-closure glaucoma, withpatent iridotomy, psuedoexfoliative glaucoma, and pigmentary glaucoma.By implanting the prostamide component-containing implants into thevitreous of an eye, it is believed that the prostamide component iseffective to enhance acqueous humour flow thereby reducing intraocularpressure.

The implants disclosed herein may also be configured to release theprostamide component or additional therapeutic agents, as describedabove, which to prevent or treat diseases or conditions, such as thefollowing:

MACULOPATHIES/RETINAL DEGENERATION: Non-Exudative Age Related MacularDegeneration (ARMD), Exudative Age Related Macular Degeneration (ARMD),Choroidal Neovascularization, Diabetic Retinopathy, Acute MacularNeuroretinopathy, Central Serous Chorioretinopathy, Cystoid MacularEdema, Diabetic Macular Edema.

UVEITIS/RETINITIS/CHOROIDITIS: Acute Multifocal Placoid PigmentEpitheliopathy, Behcet's Disease, Birdshot Retinochoroidopathy,Infectious (Syphilis, Lyme, Tuberculosis, Toxoplasmosis), IntermediateUveitis (Pars Planitis), Multifocal Choroiditis, Multiple EvanescentWhite Dot Syndrome (MEWDS), Ocular Sarcoidosis, Posterior Scleritis,Serpignous Choroiditis, Subretinal Fibrosis and Uveitis Syndrome,Vogt-Koyanagi-Harada Syndrome.

VASCULAR DISEASES/EXUDATIVE DISEASES: Coat's Disease, ParafovealTelangiectasis, Papillophlebitis, Frosted Branch Angitis, Sickle CellRetinopathy and other Hemoglobinopathies, Angioid Streaks, FamilialExudative Vitreoretinopathy.

TRAUMATIC/SURGICAL: Sympathetic Ophthalmia, Uveitic Retinal Disease,Retinal Detachment, Trauma, Laser, PDT, Photocoagulation, HypoperfusionDuring Surgery, Radiation Retinopathy, Bone Marrow TransplantRetinopathy.

PROLIFERATIVE DISORDERS: Proliferative Vitreal Retinopathy andEpiretinal Membranes, Proliferative Diabetic Retinopathy.

INFECTIOUS DISORDERS: Ocular Histoplasmosis, Ocular Toxocariasis,Presumed Ocular Histoplasmosis Syndrome (POHS), Endophthalmitis,Toxoplasmosis, Retinal Diseases Associated with HIV Infection, ChoroidalDisease Associated with HIV Infection, Uveitic Disease Associated withHIV Infection, Viral Retinitis, Acute Retinal Necrosis, ProgressiveOuter Retinal Necrosis, Fungal Retinal Diseases, Ocular Syphilis, OcularTuberculosis, Diffuse Unilateral Subacute Neuroretinitis, Myiasis.

GENETIC DISORDERS: Systemic Disorders with Accosiated RetinalDystrophies, Congenital Stationary Night Blindness, Cone Dystrophies,Fundus Flavimaculatus, Best's Disease, Pattern Dystrophy of the RetinalPigmented Epithelium, X-Linked Retinoschisis, Sorsby's Fundus Dystrophy,Benign Concentric Maculopathy, Bietti's Crystalline Dystrophy,pseudoxanthoma elasticum.

RETINAL TEARS/HOLES: Retinal Detachment, Macular Hole, Giant RetinalTear.

TUMORS: Retinal Disease Associated with Tumors, Congenital Hypertrophyof the RPE, Posterior Uveal Melanoma, Choroidal Hemangioma, ChoroidalOsteoma, Choroidal Metastasis, Combined Hamartoma of the Retina andRetinal Pigmented Epithelium, Retinoblastoma, Vasoproliferative Tumorsof the Ocular Fundus, Retinal Astrocytoma, Intraocular Lymphoid Tumors.

MISCELLANEOUS: Punctate Inner Choroidopathy, Acute Posterior MultifocalPlacoid Pigment Epitheliopathy, Myopic Retinal Degeneration, AcuteRetinal Pigment Epithelitis and the like.

In one embodiment, an implant, such as the implants disclosed herein, isadministered to a posterior segment of an eye of a human or animalpatient, and preferably, a living human or animal. In at least oneembodiment, an implant is administered without accessing the subretinalspace of the eye. For example, a method of treating a patient mayinclude placing the implant directly into the posterior chamber of theeye. In other embodiments, a method of treating a patient may compriseadministering an implant to the patient by at least one of intravitrealinjection, subconjuctival injection, sub-tenon injections, retrobulbarinjection, and suprachoroidal injection.

In at least one embodiment, a method of reducing intraocular pressure inan eye of a patient comprises administering one or more implantscontaining a prostamide component, as disclosed herein to a patient byat least one of intravitreal injection, subconjuctival injection,sub-tenon injection, retrobulbar injection, and suprachoroidalinjection. A syringe apparatus including an appropriately sized needle,for example, a 22 gauge needle, a 27 gauge needle or a 30 gauge needle,can be effectively used to inject the composition with the posteriorsegment of an eye of a human or animal. Repeat injections are often notnecessary due to the extended release of the prostamide component fromthe implants.

In addition, for dual therapy approaches to treating an ocularcondition, the method may include one or more additional steps ofadministering additional therapeutic agents to the eye, such as bytopically administering compositions containing timolol, dorzolamide,and iatoprost, among others.

In another aspect of the invention, kits for treating an ocularcondition of the eye are provided, comprising: a) a container comprisingan extended release implant comprising a therapeutic component includinga prostamide component, such as bimatoprost (Lumigan), and a drugrelease sustaining component; and b) instructions for use. Instructionsmay include steps of how to handle the implants, how to insert theimplants into an ocular region, and what to expect from using theimplants.

In certain implants, the implant comprises a therapeutic component whichconsists essentially of bimatoprost, salts thereof, and mixturesthereof, and a biodegradable polymer matrix. The biodegradable polymermatrix may consist essentially of PLA, PLGA, or a combination thereof.When placed in the eye, the implant releases about 40% to about 60% ofthe bimatoprost to provide a loading dose of the bimatoprost withinabout one day after placement in the eye. Subsequently, the implantreleases about 1% to about 2% of the bimatoprost per day to provide asustained therapeutic effect. Such implants may be effective in reducingand maintaining a reduced intraocular pressure, such as below about 15mm Hg for several months, and potentially for one or two years.

Other implants disclosed herein may be configured such that the amountof the prostamide component that is released from the implant within twodays of being placed in the eye is less than about 95% of the totalamount of the prostamide component in the implant. In certain implants,95% of the prostamide component is not released until after about oneweek of being placed in an eye. In certain implants, about 50% of theprostamide component is released within about one day of placement inthe eye, and about 2% is released for about 1 month after being placedin the eye. In other implants, about 50% of the prostamide component isreleased within about one day of placement in the eye, and about 1% isreleased for about 2 months after being placed in the eye.

Example 1 Manufacture and Testing of Implants Containing Bimatoprost anda Biodegradable Polymer Matrix

Biodegradable implants were made by combining bimatoprost with abiodegradable polymer composition. 800 mg of polylactic acid (PLA) wascombined with 200 mg of bimatoprost. The combination was dissolved in 25milliliters of dichloromethane. The mixture was placed in a vacuum at45° C. overnight to evaporate the dichloromethane. The resulting mixturewas in the form of a cast sheet. The cast sheet was cut and ground in ahigh shear grinder with dry ice until the particles could pass through asieve having a pore size of about 125 μm. The percent of bimatoprostpresent in the microparticles was analyzed using high pressure liquidchromatography (HPLC). The percent release of bimatoprost from themicroparticles was profiled using dialysis. The percent of bimatoprostremaining in the recovered particles was analyzed by HPLC.

The release profile is described in Table 1.

Time Elapsed Time Percent Percent Point (Days) Released Per Day Start 0— — 1 1.03 47.51 47.51 2 2.03 47.92 0.41 3 3.03 49.99 2.07 4 4.03 50.090.10 5 7.04 50.90 0.82

The percent loading of bimatoprost was 14.93%. The percent ofbimatoprost remaining in the recovered release particles was 4.94%.

Example 2 Extrusion Process and Compression of ManufacturingBimatoprost-Containing Biodegradable Intraocular Implants

Bimatoprost is combined with a biodegradable polymer composition in amortar. The combination is mixed with a shaker set at about 96 RPM forabout 15 minutes. The powder blend is scraped off the wall of the mortarand is then remixed for an additional 15 minutes. The mixed powder blendis heated to a semi-molten state at specified temperature for a total of30 minutes, forming a polymer/drug melt.

Rods are manufactured by pelletizing the polymer/drug melt using a 9gauge polytetrafluoroethylene (PTFE) tubing, loading the pellet into thebarrel and extruding the material at the specified core extrusiontemperature into filaments. The filaments are then cut into about 1 mgsize implants or drug delivery systems. The rods may have dimensions ofabout 2 mm long×0.72 mm diameter. The rod implants weigh between about900 μg and 1100 μg.

Wafers are formed by flattening the polymer melt with a Carver press ata specified temperature and cutting the flattened material into wafers,each weighing about 1 mg. The wafers have a diameter of about 2.5 mm anda thickness of about 0.13 mm. The wafer implants weigh between about 900μg and 1100 μg.

In-vitro release testing is performed by placing each implant into a 24mL screw cap vial with 10 mL of Phosphate Buffered Saline solution at37° C. 1 mL aliquots are removed and are replaced with equal volume offresh medium on day 1, 4, 7,14, 28, and every two weeks thereafter.

Drug assays are performed by HPLC, which consists of a Waters 2690Separation Module (or 2696), and a Waters 2996 Photodiode ArrayDetector. An Ultrasphere, C-18 (2), 5 μm; 4.6×150 mm column heated at30° C. is used for separation and the detector is set at about 264 nm.The mobile phase is (10:90) MeOH-buffered mobile phase with a flow rateof 1 mL/min and a total run time of 12 min per sample. The bufferedmobile phase may comprise (68:0.75:0.25:31) 13 mM 1-Heptane SulfonicAcid, sodium salt-glacial acetic acid-triethylamine-Methanol. Therelease rates are determined by calculating the amount of drug beingreleased in a given volume of medium over time in μg/day.

Polymers which may be used in the implants can be obtained fromBoehringer Ingelheim. Examples of polymer includes: RG502, RG752, R202H,R203 and R206, and Purac PDLG (50/50). RG502 is (50:50)poly(D,L-lactide-co-glycolide), RG752 is (75:25)poly(D,L-lactide-co-glycolide), R202H is 100% poly(D,L-lactide) withacid end group or terminal acid groups, R203 and R206 are both 100%poly(D,L-lactide). Purac PDLG (50/50) is (50:50)poly(D,L-lactide-co-glycolide). The inherent viscosity of RG502, RG752,R202H, R203, R206, and Purac PDLG are 0.2, 0.2, 0.2, 0.3, 1.0, and 0.2dL/g, respectively. The average molecular weight of RG502, RG752, R202H,R203, R206, and Purac PDLG are, 11700, 11200, 6500, 14000, 63300, and9700 daltons, respectively.

Example 3 Bimatopros/PLA/PLGA Intraocular Implants to Treat Glaucoma

A 72 year old female suffering from glaucoma in both eyes receives anintraocular implant containing bimatoprost and a combination of a PLAand PLGA in each eye. The implants weigh about 1 mg, and contain about500 mg of bimatoprost. One implant is placed in the vitreous of each eyeusing a syringe. In about two days, the patient reports a substantialrelief in ocular comfort. Examination reveals that the intraocularpressure has decreased, the average intraocular pressure measured at8:00 AM has decreased from 28 mm Hg to 14.3 mm Hg. The patient ismonitored monthly for about 6 months. Intraocular pressure levels remainbelow 15 mm Hg for six months, and the patient reports reduced oculardiscomfort.

Example 3 Bimatoprost/PLA/PLGA Intraocular Implants to Treat Glaucoma

A 72 year old female suffering from glaucoma in both eyes receives anintraocular implant containing bimatoprost and a combination of a PLAand PLGA in each eye. The implants weigh about 1 mg, and contain about500 mg of bimatoprost. One implant is placed in the vitreous of each eyeusing a syringe. In about two days, the patient reports a substantialrelief in ocular comfort. Examination reveals that the intraocularpressure has decreased, the average intraocular pressure measured at8:00 AM has decreased from 28 mm Hg to 14.3 mm Hg. The patient ismonitored monthly for about 6 months. Intraocular pressure levels remainbelow 15 mm Hg for six months, and the patient reports reduced oculardiscomfort.

Example 4 Bimatoprost/PLA Intraocular Implants to Reduce OcularHypertension

A 62 year old male presents with an intraocular pressure in his left eyeof 33 mm Hg. An implant containing 400 mg of bimatoprost and 600 mg ofPLA is inserted into the vitreous of the left eye using a trocar. Thepatient's intraocular pressure is monitored daily for one week, and thenmonthly thereafter. One day after implantation, the intraocular pressureis reduced to 18 mm Hg. By day 7 after implantation, the intraocularpressure is relatively stable at 14 mm Hg. The patient does notexperience any further signs of elevated intraocular pressure for 2years.

All references, articles, publications and patents and patentapplications cited herein are incorporated by reference in theirentireties.

While this invention has been described with respect to various specificexamples and embodiments, it is to be understood that the invention isnot limited thereto and that it can be variously practiced within thescope of the following claims.

1. A biodegradable intraocular implant comprising: a prostamidecomponent and a biodegradable polymer matrix that releases drug at arate effective to sustain release of a therapeutically effective amountof the prostamide component for at least about one week after theimplant is placed in an eye.
 2. The implant of claim 1, wherein theprostamide component comprises a single type of a prostamide derivative.3. The implant of claim 1, wherein the prostamide component is dispersedwithin the biodegradable polymer matrix.
 4. The implant of claim 1,wherein the prostamide component comprises bimatoprost provided in anamount of about 0.1% to about 90% by weight of the implant.
 5. Theimplant of claim 1, wherein the prostamide component comprises acompound having the formula (I)

wherein the dashed bonds represent a single or double bond which can bein the cis or trans configuration, A is an alkylene or alkenyleneradical having from two to six carbon atoms, which radical may beinterrupted by one or more oxide radicals and substituted with one ormore hydroxy, oxo, alkyloxy or alkylcarboxy groups wherein said alkylradical comprises from one to six carbon atoms; B is a cycloalkylradical having from three to seven carbon atoms, or an aryl radical,selected from the group consisting of hydrocarbyl aryl and heteroarylradicals having from four to ten carbon atoms wherein the heteroatom isselected from the group consisting of nitrogen, oxygen and sulfur atoms;X is a radical selected from the group consisting of —OR⁴ and —N(R⁴)₂wherein R⁴ is selected from the group consisting of hydrogen, a loweralkyl radical having from one to six carbon atoms,

wherein R⁵ is a lower alkyl radical having from one to six carbon atoms;Z is ═O or represents 2 hydrogen radicals; one of R₁ and R₂ is ═O, —OHor a —O(CO)R₆ group, and the other one is —OH or —O(CO)R₆, or R₁ is ═Oand R₂ is H, wherein R₆ is a saturated or unsaturated acyclichydrocarbon group having from 1 to about 20 carbon atoms, or—(CH₂)_(m)R₇ wherein m is 0 or an integer of from 1 to 10, and R₇ iscycloalkyl radical, having from three to seven carbon atoms, or ahydrocarbyl aryl or heteroaryl radical, as defined above, or apharmaceutically-acceptable salt thereof, provided, however, that when Bis not substituted with a pendant heteroatom-containing radical, and Zis ═O, then X is not —OR⁴.
 6. The implant of claim 1, wherein the matrixcomprises a mixture of two different biodegradable polymers, eachpolymer selected from the group consisting of polylactic acid,polyglycolic acid, polylactide-co-glycolide, derivatives thereof, andmixtures thereof.
 7. The implant of claim 6, wherein the matrixcomprises a mixture of two different polylactic acids.
 8. The implant ofclaim 6, wherein the matrix comprises a mixture of a polylactic acid anda polylactide-co-glycolide.
 9. The implant of claim 1, wherein thematrix comprises a mixture of different biodegradable polymers, eachbiodegradable polymer having a different inherent viscosity.
 10. Theimplant of claim 1, wherein the matrix comprises a mixture of differentbiodegradable polymers, each polymer having a different molecularweight.
 11. The implant of claim 1, wherein the matrix releases drug ata rate effective to sustain release of an amount of the prostamidecomponent from the implant for more than one month from the time theimplant is placed in the vitreous of the eye.
 12. The implant of claim1, wherein the therapeutically effective amount of the prostamidecomponent is an amount effective to stimulate aqueous humor outflow inthe eye in which the implant is placed.
 13. The implant of claim 1,further comprising a prostaglandin analogue.
 14. The implant of claim 13wherein the prostaglandin analog is unoprostone.
 15. The implant ofclaim 1, further comprising an intraocular pressure lowering drug otherthan a prostamide derivative.
 16. The implant of claim 1, wherein theimplant is structured to be placed in the vitreous of the eye.
 17. Theimplant of claim 1 which is formed by an extrusion process.